PNEUMOPERITONEUM RISK PROGNOSIS AND CORRECTION OF VENOUS CIRCULATION DISTURBANCES IN LAPAROSCOPIC SURGERY - A PILOT-STUDY

Background: This study was initiated to find a method of determining t he prognosis for possible changes in hemodynamic and respiratory param eters in patients with pneumoperitoneum (PP). Methods: We devised a mo del for a pseudoprieumoperitoneum (PPP), which is created by encirclin g the wide pneumochamber on the entire abdomen and inflating it to a p reset pressure. To verify the prognostic possibilities of:the proposed model, we studied the pneumotachygraphy parameters, noninvasive and i nvasive monitoring parameters of PPP after induction of anaesthesia, a nd venous circulation disturbances, as well as the medical effect of t he intermittent sequential compression device. Results: In healthy pat ients, the restrictive lung syndrome did not approach the risky limit. In patients greater than or equal to 60 years old, this syndrome was very close to the limit. In a number of patients with serious cardiova scular and pulmonary pathology, the pressure of >10 mmHg was considere d to be intolerable. Lung compliance, which was the parameter most sen sitive to the increased intraabdominal pressure, was 47 +/- 10 at base line, and 29 +/- 4 (p > 0.05)at both PPP and real PP (14 mmHg). Conclu sions: The PPP model is quite similar to the real PP and can be used f or preoperative prognosis in laparoscopic surgery. The elevated intraa bdominal pressure results in a significant disturbance of venous blood :flow in the lower extremities. The use of the device for-peristaltic pneumomassage of the lower limbs is effective in correcting negative c hanges in venous hemodynamics in laparoscopic surgery.